Young Doctor

A Young Doctor’s Notebook Other books by mikhail bulgakov published by Alma Classics Diaboliad and Other Stories Diaries and Selected Letters A Dog’s Heart The Fatal Eggs The Life of Monsieur de Molière The Master and Margarita The White Guard A Young Doctor’s Notebook Mikhail Bulgakov Translated by Hugh Aplin ALMA CLASSICS alma classics ltd London House 243-253 Lower Mortlake Road Richmond Surrey TW9 2LL United Kingdom www.almaclassics.com The stories in A Young Doctor’s Notebook first published in Russian in 1925–26. Morphine first published in Russian in 1927. This translation first published by Alma Classics Ltd (previously Oneworld Classics Ltd) in 2011 This new edition first published by Alma Classics Ltd in 2012 © by the Estate of Mikhail Bulgakov Translation and notes © Hugh Aplin, 2011 Cover © nathanburtondesign.com Background material © Alma Classics Ltd Printed in Great Britain by CPI Group (UK) Ltd, Croydon CR0 4YY isbn: 978-1-84749-286-9 All the pictures in this volume are reprinted with permission or pre sumed to be in the public domain. Every effort has been made to ascertain and acknowledge their copyright status, but should there have been any unwitting oversight on our part, we would be happy to rectify the error in subsequent printings. All rights reserved. No part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or other- wise), without the prior written permission of the publisher. This book is sold subject to the condition that it shall not be resold, lent, hired out or otherwise circulated without the express prior consent of the publisher. Contents A Young Doctor’s Notebook 1 The Towel with a Cockerel Motif 3 Baptism by Version 19 The Steel Throat 31 The Blizzard 43 Egyptian Darkness 61 The Starry Rash 75 The Missing Eye 93 Morphine 111 Note on the Texts 157 Notes 158 Extra Material 163 Mikhail Bulgakov’s Life 165 Mikhail Bulgakov’s Works 178 Select Bibliography 193 A Young Doctor’s Notebook 3 The Towel with a Cockerel Motif I f a man has never travelled in horse-drawn vehicles on remote country roads, there’s no point my telling him about it: he won’t understand anyway. And for anyone who has, I don’t even want to call it to mind. I’ll state briefly: it took me and my driver exactly twenty- four hours to travel the forty versts* that separate the small provincial town of Grachovka from the Muryino Hospi- tal.* And the exactness was even something curious: at two o’clock in the afternoon of 16th September 1917 we were by the last grain-merchant’s warehouse on the boundary of that remarkable town of Grachovka, and at five past two on the 17th September of that same unforgettable year of 1917 I was standing on the trampled, dying grass, grown soft in the light September rain, of the Muryino Hospital yard. I stood there looking like this: my legs were ossified, and to such a degree that right there in the yard I was mentally leafing through the pages of textbooks, obtusely trying to remember whether there really did exist, or whether I had imagined it in my sleep in the village of Grabilovka the night before, an illness in which a man’s muscles become ossified. What was the damned thing called in Latin? Each of those muscles ached with an unbearable pain reminiscent of toothache. I hardly need mention my toes – inside my boots they no longer moved, they lay quiet, they were like wooden stumps. I confess that in a surge of faint-heartedness I whispered 4 a young doctor’s notebook a curse on medicine and the application I had submitted to the rector of the university five years before. Rain was sprinkling down from on high at that moment as if through a sieve. My overcoat had swollen up like a sponge. In vain did I attempt to grab hold of the handle of my suitcase with the fingers of my right hand, and finally I spat on the wet grass. My fingers were unable to catch hold of anything, and being stuffed with all sorts of knowledge from interesting medical books, I again recalled an illness – palsy. “Paralysis,” I said to myself mentally, despairingly, and the devil knows why. “One has to g-get used,” I began with wooden, blue lips, “to t-travelling on your roads.” And at the same time I for some reason stared angrily at the driver, although he personally wasn’t in the least to blame for the road. “Blimey… Comrade Doctor,” the driver responded, he too barely moving his lips beneath his little fair moustache, “I’ve been travelling on ’em for fifteen years, and I still can’t get used to ’em.” I shuddered and looked round miserably at the white, two-storeyed hospital building with its peeling paint, at the unwhitewashed log walls of the feldsher’s* little house, at my own future residence – a two-storeyed, very clean building with mysterious, funereal windows – and heaved a long sigh. And at once there flashed dimly through my mind not Latin words, but a sweet phrase which, in a brain gone crazy with the rocking and the cold, was sung by a plump tenor with blue thighs: …Greetings to you… my sa-cred re-fuge…* Farewell, farewell for many a long day, to the gold and red Bolshoi Theatre, Moscow, shop windows… ah, farewell. 5 the towel with a cockerel motif “I’ll put on a sheepskin coat next time,” I thought in angry despair, trying with unbending hands to wrench the suitcase out by its straps, “I’ll… although next time it’ll already be October… it’ll make no difference if you put on two sheep- skin coats. And the soonest I’ll be going to Grachovka will be in a month, it will… Just think of it… We actually had to stop for the night! We did twenty versts and found ourselves in sepulchral darkness… night… we had to stop for the night in Grabilovka… the teacher let us in… And we left this morning at seven a.m…. And there you are driving… good heavens… slower than a pedestrian. One wheel crashes into a pothole, the other lifts up in the air, the suitcase plonks down onto your feet… then it’s over onto one side, then the other, then it’s nose first, then nape first. And down and down comes the rain from on high, and your bones grow cold. Could I possibly have believed that in the middle of a grey, sour September a man can freeze in the fields as if in a harsh winter?! But it does indeed turn out that he can. And while you’re dying your slow death, all you see is one and the same thing, just the one. To the right, a field picked bare and with a hump in it, to the left, a stunted coppice, and beside it some grey, ramshackle huts, five or six of them. And there doesn’t seem to be a single living soul inside them. Silence, silence all around…” The suitcase finally yielded. The driver had leant his stom- ach on it and shoved it out straight at me. I tried to keep hold of it by the strap, but my hand refused to work, and my distended, exasperated travelling companion, with its books and various bits and pieces, flopped straight down onto the grass, giving me a whack on the legs. “Oh dear Lor…” the driver began in fright, but I made no complaint – my legs were good for nothing anyway. “Hey, is anybody there? Hey!” the driver shouted, and started clapping his hands, making a noise like a cockerel does with its wings. “Hey, I’ve brought the doctor!” 6 a young doctor’s notebook At this point faces appeared at the dark window panes of the feldsher’s house and pressed up against them; a door slammed, and then I saw a man in an awful torn coat and tatty boots come stumping across the grass towards me. Politely and hurriedly he took off his cap, ran two paces towards me, for some reason gave a bashful smile, and greeted me in a hoarse voice. “Hello, Comrade Doctor.” “Who are you?” I asked. “I’m Yegorych,” the man introduced himself, “the watch- man hereabouts. We’ve been waiting and waiting for you…” And at once he grabbed hold of the suitcase, hoisted it up onto his shoulder and carried it off. I began limping after him, trying unsuccessfully to put my hand into my trouser pocket and take out my purse. In essence, a man needs very little. And what he needs first and foremost is fire. About to head for the backwoods of Muryino, I seem to remember promising myself while still in Moscow that I was going to conduct myself with dignity. To begin with, my youthful appearance poisoned my exist- ence. I had to introduce myself to everyone: “Dr So-and-so.” And everyone was sure to raise their eyebrows and ask: “Are you really? And there was I thinking you were still a student.” “No, I’ve graduated,” I would answer sullenly, and think: “I need to get a pair of glasses, that’s what.” But there was no reason to get a pair of glasses, my eyes were healthy, and their clarity was still unclouded by worldly experience. As I didn’t have the option of protecting myself from the customary condescending and tender smiles with the aid of glasses, I tried to develop a particular manner to inspire respect. I attempted to speak in a weighty and measured way, to keep in check as far as possible any impetuous movements, 7 the towel with a cockerel motif not to run, the way people do at twenty-three when they’re university graduates, but to walk. As I now understand, after many years have passed, none of this worked very well at all. At the moment in question I had violated this, my un- written code of conduct. I sat hunched up, sat shoeless in my socks, and sat not somewhere like my study, but in the kitchen, and, like a fire-worshipper, inspired and pas- sionate, reached out towards the birch logs glowing in the cooking stove. At my left hand stood an upturned tub, and on it lay my boots, and next to them lay a plucked, bare- skinned cockerel with a bloody neck, and in a heap next to the cockerel lay its multicoloured feathers. The fact is that, while still stiff with cold, I had managed to perform a whole series of actions demanded for life itself. Sharp-nosed Aksinya, Yegorych’s wife, I had confirmed in the position of my cook. And it was in consequence of this that the cockerel had perished at her hands. I was to eat it. I had met everyone. The feldsher was called Demyan Lukich, the midwives – Pelageya Ivanovna and Anna Nikolayevna. I had managed to go round the hospital and had satisfied myself with the utmost clarity that the stock of instruments it had was extremely rich. At the same time I was compelled to admit with the same clarity (to myself, of course) that the purpose of very many of the virginally shining instruments was completely unknown to me. Not only had I never held them in my hands, I had never, I admit it frankly, even seen them. “Hm,” I mumbled most meaningfully, “you have a marvel- lous stock of instruments though. Hm…” “Yes indeed, sir,” Demyan Lukich remarked sweetly, “it’s all through the efforts of your predecessor, Leopold Leopol- dovich. He was operating from dawn till dusk, you know.” At that point I broke out in a cold sweat and looked miser- ably at the gleaming plate-glass cabinets. 8 a young doctor’s notebook Thereafter we went round the empty wards, and I satisfied myself that they could accommodate forty people with ease. “Leopold Leopoldovich sometimes even had fifty in,” Demyan Lukich comforted me, while Anna Nikolayevna, a woman wearing a crown of grey hair, said, apropos of something or other: “You look so young, Doctor, so young. It’s simply amaz- ing. You look like a student.” “What the devil,” I thought. “Honestly, it’s like a conspiracy!” I muttered through my teeth, drily: “Hm… no, I… that is, I… yes, I do look young…” Next we went downstairs to the dispensary, and I imme- diately saw that it contained everything you could possibly think of. In two darkish rooms there was a strong smell of herbs, and on the shelves stood everything you might want. There were even some foreign patent medicines, and scarcely does it need to be added that I had never heard anything about them. “Leopold Leopoldovich ordered them,” reported Pelageya Ivanovna with pride. “This Leopold was simply a genius,” I thought, and was filled with respect for the mysterious Leopold who had abandoned quiet Murye. Besides fire, a man also needs to find his feet. I had long since eaten the cockerel, Yegorych had stuffed a hay mat- tress for me and covered it with a sheet, a lamp was burning in the study in my residence. I sat and, as if spellbound, gazed at the third achievement of the legendary Leopold: the cabinet was stuffed full of books. I cursorily counted about thirty volumes of surgery manuals alone, in Russian and German. And the books on therapy! The wonderful dermatological atlases! The evening was drawing in, and I was finding my feet. 9 the towel with a cockerel motif “I’m not to blame for anything,” I thought, stubbornly and agonizingly, “I’ve got a degree, I have top marks in fifteen exams. And I warned them in advance, while still in that big city, that I wanted to go somewhere as an assistant doctor. No. They smiled and said: ‘You’ll find your feet.’ So much for you’ll find your feet. And what if they bring me a hernia? Explain to me how I’ll find my feet with that. And in particular, how will the patient with the hernia feel in my hands? He’ll find his feet in the next world…” (at this point a chill ran down my spine) “Or what about acute purulent appendicitis? Ha! Or village children with diphtheritic croup? When a tracheotomy’s required? And even without a tracheotomy I won’t be having it so good… Or… or… childbirth! I’d forgotten about childbirth! Incor- rect lies. What ever will I do? Eh? What a frivolous man I am! I should have refused this district. I really should have. They would have got themselves some Leopold or other.” In anguish and in the dusk I paced up and down the room. When I drew level with the lamp, in the window, in the boundless darkness of the fields, I caught a glimpse of my pale visage beside the lights of the lamp. “I’m like the False Dimitry,”* I thought stupidly all of a sudden, and settled down again at the desk. I tormented myself in solitude for a couple of hours, car- rying on until such time as my nerves could simply no longer endure the terrors I had created. At that point I began to calm down and even to create certain plans. Right then… The numbers coming to surgery, they say, are insignificant just now. They’re breaking flax in the villages, the roads are impassable… “And it’s now that they’ll bring you a hernia,” thundered a stern voice in my brain, “because a man with a cold (an uncomplicated illness) won’t travel on impassable roads, but they will struggle in here with a hernia, you rest assured, dear colleague Doctor.” 10 a young doctor’s notebook The voice wasn’t stupid, was it? I winced. “Be quiet,” I said to the voice, “there doesn’t have to be a hernia. What’s this neurasthenia? If a job’s once begun, never leave it till it’s done.” “You’ve made your bed, now lie in it,” the voice responded snidely. Right then… I’ll never part with my handbook… If some- thing needs to be prescribed, you can think it over while you’re washing your hands. The handbook will lie open directly on top of the patient register. I’ll write helpful, but uncomplicated prescriptions. Well, for example, one 0.5 sachet of natrii salicylici powder three times a day. “You can prescribe soda!” responded my internal inter- locutor, manifestly mocking me. What’s soda got to do with it? I’ll prescribe Cephaelis ipecacuanha as well – infusum…* 180. Or two hundred. If you please. And straight away, although no one was demanding any ipecacuanha of me in my solitude by the lamp, I leafed faint-heartedly through the prescription handbook, checked on ipecacuanha, and in passing read mechani- cally about the existence of some stuff “insipin” too. It’s none other than “ethereal sulphate of quinine-diglycolic acid”… Apparently it doesn’t taste of quinine! But what’s it for? And how is it prescribed? What is it – a powder? The devil take it! “Insipin’s all very well, but what will happen with the hernia all the same?” terror in the form of the voice persisted in badgering me. “I’ll sit it down in a bath,” I defended myself frenziedly, “in a bath. And I’ll try and put it back in place.” “A strangulated one, my angel! What use are baths then, damn it! A strangulated one,” sang terror in the voice of a demon. “You have to operate…” 11 the towel with a cockerel motif At that point I gave in and almost burst into tears. And I sent an entreaty to the darkness beyond the window: any- thing you like, only not a strangulated hernia. And tiredness crooned: “Go to bed, you ill-starred Aesculapius.* Have a good sleep, and in the morning you’ll see. Calm down, you young neurasthenic. Look – the darkness beyond the windows is at peace, the cooling fields are asleep, there is no hernia. And in the morning you’ll see. You’ll find your feet… Sleep… Put the atlas down… You won’t understand a darned thing now anyway. The hernia ring…” How he had flown in I couldn’t even comprehend. I seem to recall that the bolt on the door had made a clatter, and Aksinya had said something in a squeak. And a cart had creaked by outside the windows too. He was hatless, in an unbuttoned sheepskin jacket, with a tangled little beard and crazed eyes. He crossed himself and fell to his knees and banged his forehead against the floor. This was to me. “I’m done for,” I thought in anguish. “What are you doing, what are you doing?” I mumbled, and pulled at his grey sleeve. His face was contorted, and in reply, choking, he started to mumble some jerky words: “Mr Doctor… Mr… my only, my only… my only one!” he cried out suddenly in a youthfully resonant voice that made the lampshade quiver. “Oh Lord… Oh…” He wrung his hands in anguish, and again began banging his forehead against the floorboards as though he wanted to crack it open. “Why? Why this punishment?… How have we an- gered You?” “What? What’s happened?” I cried out, sensing that my face was growing cold. 12 a young doctor’s notebook He leapt to his feet, lurched back and forth, and then this is what he whispered: “Mr Doctor… whatever you want… I’ll give you money… Take the money, as much as you want. As much as you want. We’ll bring you food… Only she mustn’t die. She mustn’t die. If she remains a cripple – so be it. So be it!” he shouted at the ceiling. “There’s enough to keep her fed, there’s enough.” Aksinya’s pale face hung in the black square of the door. Anguish was entwining itself around my heart. “What?… What? Tell me!” I cried out painfully. He fell quiet, and in a whisper, as though confidentially, he said to me – and his eyes became fathomless: “She fell into the brake…” “The brake, the brake?…” I repeated. “What’s that?” “Flax, they were breaking flax… Mr Doctor…” Aksinya explained in a whisper, “the brake… they’re breaking flax…” “This is the start. This is it. Oh, why did I come?!” I thought in horror. “Who?” “My daughter,” he replied in a whisper, and then shouted: “Help!” And he fell to the ground once more, and his hair, cut in a fringe, flopped down over his eyes. The two horns of the kerosene lamp with its crooked tin shade were burning hotly. On the operating table, on a white, fresh-smelling oilcloth, I saw her, and the hernia faded from my memory. Fair, slightly reddish hair hung down from the table in disorder, dry and matted with plica polonica.* The plait was gigantic, and its end was touching the floor. The cotton skirt was torn to pieces, and the blood on it was of different colours – a brown patch, a rich, scarlet patch. The light of the kerosene lamp seemed to me yellow and alive, and her face like paper, white, with the nose sharpened. 13 the towel with a cockerel motif On her white face, motionless, plaster-like, a truly rare beauty was dying away. It’s not every day, not often that you’ll encounter such a face. For about ten seconds there was complete silence in the operating room, but outside the closed doors someone could be heard letting out indistinct cries and banging, continually banging their head. “He’s lost his senses,” I thought, “so the nurses are giving him a drink… Why such a beauty? Though he does have regular features… The mother was evidently beautiful… He’s a widower…” “Is he a widower?” I whispered mechanically. “He is,” Pelageya Ivanovna replied quietly. At that point, with an abrupt, almost angry movement, Demyan Lukich tore the skirt apart from bottom to top and all at once laid her bare. I looked, and what I saw exceeded my expectations. The left leg, as such, wasn’t there. Starting from the shattered knee, there lay bloody shreds and red, mangled muscles, and poking out sharply in all directions were white, crushed bones. The right one was fractured at the shin in such a way that the ends of both pieces of bone had broken through the skin and come out. Because of this her foot lay lifeless, seemingly apart, turned to one side. “Yes,” said the feldsher quietly, and added nothing more. At that point I emerged from my benumbed state and felt for her pulse. It wasn’t there in her cold arm. Only after several seconds did I find a scarcely perceptible, isolated rip- ple. It passed… then there was a pause, during which I had time to glance at the wings of her nose, which were turning blue, and her white lips… Already I wanted to say: “It’s the end…” Fortunately, I restrained myself… The thread-like ripple came again. “This is how a person torn to pieces dies away,” I thought, “there’s absolutely nothing you can do here…” 14 a young doctor’s notebook But suddenly, not recognizing my own voice, I said sternly: “Camphor.” At this point Anna Nikolayevna leant towards my ear and whispered: “Why, Doctor? Don’t torment her. Why another injec- tion? She’s going to pass away at any moment… You won’t save her.” I looked round at her, angry and sullen, and said: “I’m asking for camphor…” Such that Anna Nikolayevna, with a flushed, offended face, immediately rushed to the table and broke open an ampoule. The feldsher evidently disapproved of the camphor too. Nonetheless, he deftly and quickly took hold of a syringe and the yellow oil passed under the skin on the shoulder. “Die. Hurry up and die,” I thought, “die. Or else what ever am I going to do with you?” “She’ll be dead in a moment,” whispered the feldsher, as though he had guessed my thoughts. He threw a sidelong glance at a sheet, but evidently changed his mind: it was a shame to get blood on the sheet. However, a few seconds later she had to be covered up. She was lying like a corpse, but she wasn’t dead. Suddenly things in my head became light, like under the glass roof of our distant anatomical theatre. “More camphor,” I said hoarsely. And again the feldsher obediently injected the oil. “Is she really not going to die?” I thought despairingly. “Am I really going to have to…” Everything in my brain was lightening, and suddenly, without any textbooks, without advice, without assistance, I understood – with an iron certainty that I had understood – that now, for the first time in my life, I was going to have to perform an amputation on a person who was unconscious. And that person was going to die under the knife. She had no blood, after all! In the course of ten versts, everything 15 the towel with a cockerel motif had flowed out through the shattered legs, and it was even uncertain whether she could feel anything now, whether she could hear. She was silent. Oh, why didn’t she die? What would her crazed father say to me? “Prepare for amputation,” I said to the feldsher in a voice not my own. The midwife gave me a wild look, but there was a brief spark of sympathy in the feldsher’s eyes, and he started bustling about by the instruments. The Primus let out a roar beneath his hands… A quarter of an hour passed. With superstitious horror I kept peering into an unconscious eye, lifting the cold lid. I couldn’t grasp a thing… How could a semi-corpse be alive? Beads of sweat ran unrestrainedly down my forehead from under my white cap, and Pelageya Ivanovna wiped the salty sweat away with a piece of gauze. Swimming in the remnants of the blood in the girl’s veins there was now caffeine too. Should it have been injected or not? Anna Nikolayevna, barely touching, was stroking out the bumps that had swol- len up on the hips because of the saline. But the girl was alive. I picked up a knife, trying to imitate somebody (I had seen an amputation once in my life at university)… I was now begging Fate not to let her die in the next half-hour… “Let her die in the ward when I’ve finished the operation…” Only my common sense was working on my behalf, driven on by the extraordinariness of the situation. With an ex- tremely sharp knife, like an experienced butcher, I made a deft, circular slash around the hip, and the skin parted without producing a single droplet of blood. “What will I do if the vessels start bleeding?” I thought, and cast side- long looks, like a wolf, at a heap of torsion forceps. I cut off an enormous morsel of female meat with one of the blood vessels – it was in the form of a little whitish tube – but not a drop of blood came out of it. I clamped it with 16 a young doctor’s notebook torsion forceps and moved on. I clipped the torsion forceps on everywhere that I assumed there to be blood vessels… “Arteria… arteria… What the devil’s the name?…” The operating room began to look like a clinic. Torsion forceps hung in bunches. They were pulled up and out of the way, along with the meat, with gauze, and with a dazzling, finely serrated saw I began sawing the round bone. “Why doesn’t she die?… It’s amazing… oh, how a person clings to life!” And the bone fell away. Left in Demyan Lukich’s hands was what used to be a girl’s leg. Tatters, meat, bones! All this was thrown aside, and on the table was a girl, seem- ingly a third shorter, with a stump pulled away to one side. “Just a little more… don’t die,” I thought, inspired, “hang on until the ward, let me get out safe and sound from this terrible event in my life.” Then the ligatures were tied, then, clicking the Collin,* I started sewing up the skin with well-spaced stitches… but I stopped as it dawned on me and I realized… I left an out- flow… inserted a gauze tampon… Sweat was flooding my eyes, and it seemed to me as though I were in a bathhouse… I let out a long breath. Looked gravely at the stump, at the waxen face. Asked: “Alive?” “Alive…” responded both the feldsher and Anna Nikolayev- na at once, like a soundless echo. “She’ll live a moment more,” the feldsher spoke into my ear soundlessly, with his lips alone. Then he hesitated, and tactfully advised: “Perhaps the second leg shouldn’t be touched, Doctor. We’ll bind it up with gauze… or else she won’t make it to the ward… Eh? After all, it’s better if she doesn’t pass away in the operating room.” “Give me plaster,” I responded huskily, prompted by an unknown force.